Effect of Antihyperglycemic Agents Added to Metformin and a Sulfonylurea on Glycemic Control and Weight Gain in Type 2 Diabetes: A Network Meta-analysis

被引:127
作者
Gross, Jorge L. [1 ]
Kramer, Caroline K. [1 ]
Leitao, Cristiane B. [1 ]
Hawkins, Neil [1 ]
Viana, Luciana V. [1 ]
Schaan, Beatriz D. [1 ]
Pinto, Lana C. [1 ]
Rodrigues, Ticiana C. [1 ]
Azevedo, Mirela J. [1 ]
机构
[1] Univ Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Div Endocrinol, BR-90035003 Porto Alegre, RS, Brazil
关键词
BIPHASIC INSULIN ASPART; BEDTIME INSULIN; DOUBLE-BLIND; ROSIGLITAZONE; GLARGINE; EXENATIDE; THERAPY; COMBINATION; MANAGEMENT; EFFICACY;
D O I
10.7326/0003-4819-154-10-201105170-00007
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Few studies have examined the effect of adding a third antihyperglycemic drug when blood glucose control is not achieved by using metformin and a sulfonylurea. Purpose: To compare the efficacy of add-on antihyperglycemic drugs in patients with type 2 diabetes that is not controlled with metformin and a sulfonylurea. Data Sources: MEDLINE, EMBASE, Cochrane Library, LILACS, and ClinicalTrials.gov electronic databases. Study Selection: Randomized trials at least 24 weeks in duration. Studies evaluated the effects of adding a third antihyperglycemic drug to treatment of adults aged 18 years or older with type 2 diabetes and a hemoglobin A(1c) (HbA(1c)) level greater than 7.0% who were already receiving a combination of metformin and a sulfonylurea. Data Extraction: Primary end points were change in HbA(1c) level, change in weight, and frequency of severe hypoglycemia. Data Synthesis: Eighteen trials involving 4535 participants that lasted a mean of 31.3 weeks (24 to 52 weeks) were included. Compared with placebo, drug classes did not differ in effect on HbA1c level (reduction ranging from -0.70% [95% credible interval {CrI}, -1.33% to -0.08%] for acarbose to -1.08% [CrI, -1.41% to -0.77%] for insulin). Weight increase was seen with insulins (2.84 kg [CrI, 1.76 to 3.90 kg]) and thiazolidinediones (4.25 kg [CrI, 2.76 to 5.66 kg]), and weight loss was seen with glucagon-like peptide-1 agonists (-1.63 kg [CrI, -2.71 to -0.60 kg]). Insulins caused twice the absolute number of severe hypoglycemic episodes than noninsulin antihyperglycemic agents. Limitations: Most of the trials were short term, and trial quality varied. With so few trials relative to antihyperglycemic agents, investigators relied on indirect comparisons, which increased the uncertainty of the findings and conclusions. Conclusion: There is no clear difference in benefit between drug classes when adding a third agent to treatment of patients with type 2 diabetes who are already receiving metformin and a sulfonylurea. The most appropriate option should depend on each patient's clinical characteristics.
引用
收藏
页码:672 / +
页数:11
相关论文
共 32 条
[1]  
[Anonymous], Global guideline for type 2 diabetes
[2]   OPERATING CHARACTERISTICS OF A BANK CORRELATION TEST FOR PUBLICATION BIAS [J].
BEGG, CB ;
MAZUMDAR, M .
BIOMETRICS, 1994, 50 (04) :1088-1101
[3]   Scope and impact of financial conflicts of interest in biomedical research - A systematic review [J].
Bekelman, JE ;
Li, Y ;
Gross, CP .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 289 (04) :454-465
[4]   Efficacy and safety of biphasic insulin aspart 70/30 versus exenatide in subjects with type 2 diabetes failing to achieve glycemic control with metformin and a sulfonylurea [J].
Bergenstal, Richard ;
Lewin, Andrew ;
Bailey, Timothy ;
Chang, Denise ;
Gylvin, Titus ;
Roberts, Victor .
CURRENT MEDICAL RESEARCH AND OPINION, 2009, 25 (01) :65-75
[5]   Insulin glargine provides greater improvements in glycaemic control vs. intensifying lifestyle management for people with type 2 diabetes treated with OADs and 7-8% A1c levels. The TULIP study [J].
Blickle, J. -F. ;
Hancu, N. ;
Piletic, M. ;
Profozic, V. ;
Shestakova, M. ;
Dain, M. -P. ;
Jacqueminet, S. ;
Grimaldi, A. .
DIABETES OBESITY & METABOLISM, 2009, 11 (04) :379-386
[6]   Initial monotherapy with either metformin or sulphonylureas often fails to achieve or maintain current glycaemic goals in patients with Type 2 diabetes in UK primary care [J].
Cook, M. N. ;
Girman, C. J. ;
Stein, P. P. ;
Alexander, C. M. .
DIABETIC MEDICINE, 2007, 24 (04) :350-358
[7]   Glycemic control continues to deteriorate after sulfonylureas are added to metformin among patients with type 2 diabetes [J].
Cook, MN ;
Girman, CJ ;
Stein, PP ;
Alexander, CM ;
Holman, RR .
DIABETES CARE, 2005, 28 (05) :995-1000
[8]   Glycemic control with glyburide/metformin tablets in combination with rosiglitazone in patients with type 2 diabetes: A randomized, double-blind trial [J].
Dailey, GE ;
Noor, MA ;
Park, JS ;
Bruce, S ;
Fiedorek, FT .
AMERICAN JOURNAL OF MEDICINE, 2004, 116 (04) :223-229
[9]   Differences in effects of insulin glargine or pioglitazone added to oral anti-diabetic therapy in patients with type 2 diabetes What to add-Insulin glargine or pioglitazone? [J].
Dorkhan, Mozhgan ;
Frid, Anders ;
Groop, Leif .
DIABETES RESEARCH AND CLINICAL PRACTICE, 2008, 82 (03) :340-345
[10]   Effects of bed-time insulin versus pioglitazone on abdominal fat accumulation, inflammation and gene expression in adipose tissue in patients with type 2 diabetes [J].
Hartemann-Heurtier, Agnes ;
Halbron, Marine ;
Golmard, Jean-Louis ;
Jacqueminet, Sophie ;
Bastard, Jean-Philippe ;
Rouault, Christine ;
Ayed, Amine ;
Pieroni, Laurence ;
Clement, Karine ;
Grimaldi, Andre .
DIABETES RESEARCH AND CLINICAL PRACTICE, 2009, 86 (01) :37-43